Simultaneous occurrence of Papillary Carcinoma and Medullary Carcinoma / Journal of the ASEAN Federation of Endocrine Societies

@#The cell origin, histopathologic features, and prognosis of medullary and papillary thyroid carcinoma are different and to have them occur simultaneously in a single patient is a rare occurrence. This is a case of a 38-year-old female who presented with an enlarging anterior neck mass whose fine needle aspiration biopsy could not rule out a papillary lesion. Thus, she was advised to undergo total thyroidectomy, and her final histopath showed a simultaneous medullary and papillary thyroid carcinoma. Her initial serum calcitonin was elevated at 252 pg/ ml, and it remained persistently elevated over the course of 7 months. A repeat ultrasound revealed solid nodules with coarse calcifications and enlarged lymph nodes at both submandibular regions. This warranted a repeat surgery with neck dissection with the finding of eight lymph nodes positive for metastatic carcinoma. On follow up after her second surgery, the calcitonin decreased to 42.70 pg/ml. Knowledge of this simultaneous occurrence of medullary thyroid carcinoma and papillary cancer is important for its prognostic implications and therapeutic plan

Validity of Ankle Brachial Index using Palpation Method in screening for Peripheral Arterial Disease in Type 2 Diabetes Mellitus patients at a tertiary hospital in the Philippines / Journal of the ASEAN Federation of Endocrine Societies

Introduction@#Peripheral Artery Disease (PAD) is a significant marker of cardiovascular disease and is prevalent but underdiagnosed. Ankle-Brachial Index (ABI) is the recommended screening test for PAD. However, not all clinics have a Doppler ultrasound. ABI by palpation offers a more feasible alternative. @*Objective@#This study aims to determine the validity of ABI measurement by palpation method in the screening of PAD.@*Methodology@#This prospective validation study utilized a cross-sectional analytic design. Three physicians performed the ABI by palpation method and their result was compared to the Doppler ABI. The accuracy indices for validation was computed per physician conducting the ABI by palpation and also as an average of all 3 palpation method readings. During the course of sampling, there were no patients with severe PAD found during the prospective period.@*Results@#The accuracy of Ankle Brachial Index using Palpation method yielded the following ranges, sensitivity between 63.16 % - 73.68%, specificity of 94.06% - 98.02%, PPV within 85.37% - 95.45%, and NPV within 80.73% - 86.84% in predicting PAD. The accuracy indices were clinically acceptable. Meanwhile, the raters’ usage of Ankle Brachial Index using Palpation method demonstrated a substantial agreement with ABI by Doppler Method performed by the angiologist (Cohen Kappa >0.60).@*Conclusion@#The ABI by palpation is a good screening tool for PAD, but the person performing it must be adequately trained to do the procedure. The procedure is affordable and convenient, and should be done routinely during clinic visits in the physical examination of patients with known risk factors for PAD.